Blogathon: John Arderne’s Practica of fistula-in-ano: hitting a bum note?

Crimson boils; phallic-seeming plants; both kinds of moon; a portrait of a smiling gentleman with a bright red penis; all of these feature in the pages of MS Hunter 112, otherwise known as John Arderne’s ‘Account of Operation’. A medical handbook and full account of the procedure to cure fistula-in-ano (when an infection of the anal crypt leads to an abscess or fistula, an opening between the anal canal and the opening of the skin), this 15th c. manuscript holds a gruesome fascination for many who come across it. But what about Arderne himself? The author of this text is seen by many as the most successfully innovative surgeon of the Middle Ages; others posit that he was a fraudulent scamp. Let us examine the evidence, and try to get to the bottom of this mystery.

CASE FOR: Arderne was a brilliant and compassionate surgeon, advancing both medical texts and medical techniques, thus laying foundations for the future of medical science.

His text’s innovationsThe Practica’s originality—and worth – is proved in its continuous use until the 17th c. (a Dublin surgeon’s annotated copy from 1645 survives), and its many and varied extant copies in both Latin and Middle English translations (Murray Jones, 2004, 1; see MS Hunter 112 and 251). Although Arderne’s other works range from disorganised to derivative via the patently useless, this text contains many features which barely occur in other medieval medical manuscripts, or at least not with any regularity. To wit:

Step-by-step instructions for the procedure are given, and shown in full-page illustrations (where most MSS contain relevant or irrelevant marginalia). (45r)

Lists of possible complications are given, as well as illnesses that are not-to-be confused with fistula; this is a highly irregular level of detail.

Arderne fully describes and illustrates his instruments. (44 v)

A prescriptive list of unguents, medications and herbs to be used before and after the surgery is included, not just an alphabetical compendium included at the back of the codex (see, e.g, MS Hunter 513). (53 v).

Only one operation is discussed (typically, medieval surgeries contain many-an-ailment; see MS Hunter 307, a pharmacopoeia which contains everything from treating dropsy to suggestions for diet if ‘feblenesse’ is an issue.)

He was instrument-al to medical science :Not one to rest on his laurels, but keen that his patients could rest on theirs, Arderne was the inventor of several medical instruments that improved his surgeries. Practica reveals the tendiculum, an instrument ‘used as a dilator, and also as a means of tightening the cord which passes through the fistula and rectum.’ .(Jones, 2004, 2) (45 r)

He was a Ladies’ Man:
Arderne was also straight-talking when it came to conduct, and was keen to preserve dignity all round when it came to his female patients:

‘He shall not look too openly at the lady or the daughters or other fair women in great men’s houses, nor proffer to kiss them, nor touch either secretly or openly their breasts, nor their hands, nor their pubes.’ (Extract transl. Power, 1910,5.)

A charming admonition, especially from the days when heiress rape was considered a well-spent Tuesday lunchtime.

He was flexible with his bottom line:Recent sources (see Zimmerman,2003,159) have suggested that Arderne was the pioneer of sliding payment scales for necessary professional services; in other words, he was the Atticus Finch of the backside. His belief that peasants should be seen for free whilst knights should pay hand over fist(ula) for their treatment brought balance to the poor man’s seemingly futile (feudal?) existence . In turn, his high prices seem less like chicanery and more like good business–and social–sense.

He illustrates his points so beautifully:And let’s not forget the reason we all love this manuscript: grizzly sketches of squishy bits! But apart from their obvious appeal, their functionality is , in the medieval medical manuscript tradition, beyond compare. Peter Murray Jones has suggested that ‘No other medical author of the middle ages (sic) was so effectively illustrated,’ (Jones, 2004,3) and such detailed images aided the successful practice of these surgeries. MS Hunter 112 also boasts pentangles, plants, astrological symbols, portraits (most notably of the subject, Sir Thomas Hewmarch’s son, who appears accountably happy post-surgery : (95r)

Some marvellous marginal grotesques: (59v)

And a little lion man: (60 v).

But Arderne’s work isn’t all cheerful astrologers, lords, and other zoo animals. Let us estimate the quackery with the following evidence.

CASE AGAINST: Arderne was a vigorous self-publicist, as greedy as Chaucer’s Doctor of Physic, and sporting some serious, Jeff-Winger-level false qualifications.

His credentials were unsupported:Arderne was not affiliated with any university, and there are no records of independent testimony to the statement that he was ‘most noble of surgeons’ (a statement of support–included four times in his works–from W. Hockesworth of Wiltshire ,of whom we have no other record.)

He had small Latin and less Greek:For a supposed Master Surgeon (one well-acquainted with the corpus of Latin medical texts) Arderne’s Latin was pretty patchy. Like a medieval Del Boy, his work often includes random words, phrases and chunks of text in various European vernaculars.

He was a Hippo-crite:For all his blustering that he was the only surgeon able to perform this procedure, tracing the method proves that it was part of the Hippocratic corpus (Murray Jones, 2004, 1).

He drew a bum deal:Despite his sliding scale, Arderne was ‘not timid in the matter of fees’ (Zimmerman, 2003, 158). The text of Practica suggests that a doctor should take no less than five pounds for the surgery, and there are records of Arderne taking up to forty pounds for a procedure, which works out at around £19,000 in today’s money. (cf. Gardham, 2004, 36; The National Archives’ currency conversion calculator, a.k.a. the greatest procrastination tool in the world, is available here: http://www.nationalarchives.gov.uk/currency/)And so there we have it—possible genius, possible chicanery, but a definitively fascinating manuscript. Whatever the truth of Arderne’s biography, one thing is for sure: there may have been piles of work to be done in medieval medicine, but Arderne could never have been accused of sitting on the problem. (87v)

Power, D’Arcy. Treatises of Fistula in Ano; Haemorrhoids and Clysters. From an Early Fifteenth-century Manuscript Translation. Edited by D’Arcy Power. London, NY: Published for the Early English Text Society by the Oxford Univ., 1910. Print.

Zimmerman, Leo M., and Ilza Veith. Great Ideas in the History of Surgery (New York: Dover, 1967)

2 replies

O, I remember seeing this manuscript when I was doing my Medieval and Renaissance Studies MPhil – it was most entertaining. Isn’t there a picture of a penis tree in there somewhere? I cannot believe I just wrote that sentence, hee. Excellent puns as well – I approve!

Thanks for this post, a lovely, if slightly icky, trip down memory lane.